Other benefits

If you are on the Standard Care Plan and you or dependants require treatment for alcohol or drug dependency, you will need to obtain authorisation for the admission by phoning 0860 222 633.

SANCA (The South African National Council for Alcoholism and Drug Dependence) or SANCA approved facilities, are the Scheme Designated Service Provider (DSP) for alcohol and drug treatment. Hospitalisation is limited to 21 days per beneficiary per annum.

Out of hospital alcohol and drug treatment is limited to the Overall Out of Hospital Family Limit and sublimit 2 of R6 120 per adult, Child: R3 060 per child per year.

Anglo Medical Scheme manages renal (kidney) dialysis and transplants to ensure that the correct treatment protocols are adhered to and that members get the most cost-effective care.

Should kidney failure occur, members need to ensure that their specialist contacts the Scheme to authorise a treatment plan.

Once the application has been assessed and authorised, the appropriate treatment may begin.

Standard Care Plan members need to phone the Scheme on
0860 222 633.

The Scheme funds organ transplants in accordance with the organ transplant management programme.

Call 0860 222 633 to register on the program and to receive authorisation.

Cover includes the harvesting of the organ, post-operative care of the member and the donor and anti-rejection medicine. All costs for the organ donation for any person other than a member or registered dependant of the Scheme are excluded.

If you have been diagnosed with chronic obstructive airways disease and require oxygen therapy, please contact the Call Centre on
0860 222 633 for more information.

We fund all PMB radiology at 100% of the Scheme Reimbursement Rate (SRR) according to Scheme protocols.

Non-PMB out of hospital radiology is subject to an Annual Family Limit of: R2 155 per adult, R1 300 per child.

You are entitled to 100% of the SRR for radiology services and costs of materials. These include specialised radiology (i.e. MRI and CT scans, Isotope therapy, mammogram and one bone densitometry scan).

Bone densitometry scans are limited to one per beneficiary per year. Call 0860 222 633 for authorisation.

We fund all PMB pathology at 100% of the Scheme Reimbursement Rate (SRR) according to Scheme protocols.

Non-PMB out of hospital pathology is subject to an annual Pathology Family Limit of R1 650 per adult, R595 per child per year. You are entitled to 100% of the SRR for pathology services and costs of materials.

The Scheme will not pay for DNA testing and investigations, including genetic testing for familial cancers and paternal testing.

Standard Care Plan funds hospice services instead of hospitalisation (in-patient care facility and out-patient home care). To obtain an authorisation call 0860 222 633. Subject to Scheme protocols.

Infertility is characterised as the incapacity of a couple to conceive despite engaging in regular, unprotected intercourse. Primary infertility pertains to couples who haven't been able to conceive for at least a year; secondary infertility applies to couples who have previously conceived but are now unable to have additional children. The term also encompasses recurrent miscarriages.

Subject to clinical entry criteria and pre-authorisation by the Scheme, a beneficiary is entitled to 100% of the SRR, or actual cost, if lower, of acute care in lieu of hospitalisation.

Acute level care taking place in the home environment supported by real-time monitoring and wearable devices, as well as hospital level diagnostics and interventions.

Subject to the following Hospital at Home DSP providers:

• Discovery Hospital at Home
• Mediclinic at Home
• Quro Medical

Members have access to step-down facilities instead of hospitalisation, where intermediate care is necessary, subject to protocols. Contact the Call Centre on 0860 222 633 for authorisation.